Birth Control and Contraception Options: An A-to-Z Guide

It’s a fact: As a woman, if you have sex with a man, it’s possible to get pregnant. But if you don’t want to get pregnant, there are many forms of birth control to help prevent pregnancy.

Birth Control: A Definition and Overview

Also called contraception, birth control has several different options. While abstinence, or refraining from intercourse, is the only way to prevent pregnancy with 100 percent certainty, there are both nonhormonal and hormonal methods of contraception.

Nonhormonal methods generally create a physical barrier between the sperm and the egg. There are also two permanent methods requiring surgery: sterilization, or tubal ligation, for women, and vasectomy for men.

Hormonal methods generally make it less likely that a woman will release an egg, that an embryo will form, or that an embryo will be implanted.

What’s the Best Birth Control Method?

“It varies, and it depends on you and your lifestyle,” says Keosha T. Bond, doctor of education, an assistant professor of epidemiology at New York Medical College in Valhalla, New York. “I try to explain there’s no 'one size fits all.' It’s more, ‘What can I do, and how does my body react?’ There are so many contraceptive methods out there, but every one won’t fit every person.”

Emergency Contraception and Next-Day Birth Control

In addition to the many methods detailed in the list of contraception options, today women have access to emergency contraception (EC). Sometimes called next-day birth control or the morning-after pill, EC is a safe way to prevent pregnancy up to five days after unprotected sex.

Choosing the Right Birth Control Method for You

Birth control methods are measured based on perfect use — meaning when they are used correctly every single time — and actual use, which is a more typical basis. For example, if birth control pills are supposed to be taken at the same time every single day, perfect use means the person is taking those pills exactly as directed. Typical use would mean that the pills were perhaps taken most of the time, but not every single day, or not at the same time every single day.

Available Birth Control Methods: All Your Contraception Options

Here’s a look at every kind of birth control available today:

Type of Contraception: Hormonal Birth Control

Contraception based on hormones help alter how your body works to get and stay pregnant. These range from daily use options, such as birth control pills, to long-term use approaches, such as hormone-based IUDs, which stay in place for several years, says Dr. Bond.

Hormonal Contraception Option: Birth Control Pills

There are many different kinds of birth control pills available, including high and low doses of hormones, some that change dosages based on a woman’s cycle, and others that give the same amount all month long, says Bond.

Some important facts:

Pills need to be taken every day, typically at the same time each day.

Depending on health insurance coverage, birth control pills may cost nothing or up to $113 per month, according to Bedsider. (1)

Hormonal Birth Control Side Effects

Some people don’t do well on hormonal contraception, which typically includes either estrogen, a form of progesterone called progestin, or a combination of the two. “Each woman is different, and you have to understand your body,” says Bond. If you notice one or more of these side effects, let your doctor know:

Nausea

Weight gain

Changed menstrual cycles, including spotting

Who Shouldn’t Take Hormonal Birth Control?

For some people, using hormones is not recommended. “The pill is easy and awesome, but if you have migraines with aura (vision changes during a bad headache), or have a history of deep vein thrombosis, stroke, or other cardiac changes,” talk to your doctor to learn if you should consider another birth control option, says Christine Carlan Greves, MD, an ob-gyn based in Orlando, Florida. “If you have a blood clotting disorder, or breast cancer, you don’t want to take progesterone,” she added. Smokers, and those considered overweight or obese, should talk to their doctors about which contraceptives are recommended for them.

Before the Birth Control Pill Existed

When the birth control pill was first introduced in 1960, it changed everything, especially for women.

Reliable contraception was scarce a hundred years ago. For women, having sexual intercourse meant risking pregnancy. Prior to the arrival of the pill, withdrawal and abstinence were the main birth control methods available. And there were other risks and obstacles related to using birth control to space or prevent pregnancies. One big obstacle was the Comstock Act of 1873, which made birth control illegal.

More on Period Health

According to Planned Parenthood, fully one-third of the wage gains made by American women since the 1960s can be traced back to oral contraceptives. Between 1970 and 1990, hormonal birth control accounted for some 30 percent of the increase in the rate of women entering skilled careers like medicine and law. The birth control pill has also been the most influential factor enabling women to stay in college.

Hormonal Contraception Option: The Shot, Depo, or Depo-Provera

Known by the above names, an injection of Depo-Provera can help prevent pregnancy for three months. It’s a shot of progestin, which works by keeping your ovaries from releasing eggs, as well as thickening the cervical mucous so sperm can’t travel effectively.

Getting injections is private and done at your doctor’s office regularly every quarter. It also doesn’t require a monthly prescription or regular pharmacy trips.

It can cost nothing or up to $100, according to Planned Parenthood. (2)

Hormonal Contraception Option: Arm Implant, Nexplanon, or Implanon

This is a small rod about the size of a matchstick that is placed into the upper arm. It releases progestin, which prevents your body from releasing eggs, and makes it tougher for sperm to move. It’s good for up to four years of pregnancy protection.

It needs to be inserted in a healthcare provider’s office.

It is 99 percent effective for both perfect and typical use.

Most of the time it is covered for free but it can be expensive if not. Still, over the course of four years, it will end up costing about $10 per month, per Bedsider. (3)

Hormonal Birth Control Option: Vaginal Ring or NuvaRing

Like many birth control pills, the vaginal ring contains both progestin and estrogen. Unlike oral pills, a woman inserts the ring into her vagina (similar to inserting a tampon) and the hormones work to prevent ovulation and pregnancy. It is worn each month and needs to be changed on a specific schedule, typically after three weeks, with a week off for a period. Then a new ring is inserted for the next cycle.

You can use the ring to skip your period every month if you want, which is considered safe to do.

Hormonal Birth Control Option: The Patch

Resembling a small square Band-Aid, the beige contraceptive patch is worn on the skin and infuses estrogen and progestin so that ovulation doesn’t happen. It needs to be changed out every week and is available in generic form known as Xulane. (5)

Type of Contraception: Intrauterine device, or the IUD

IUDs (short for intrauterine device) are one of the most effective forms of birth control — they're more than 99 percent effective against pregnancy. Once recommended only for women who've already had children, experts now say that women who haven’t had children can effectively use an IUD.

IUDs are inserted into the uterus by a healthcare professional, and can work for 3 to 12 years, depending on which one you choose. They can also be removed any time if a woman wants to try to get pregnant.

Different IUDs on the Market

There are five kinds of IUDs available in the United States. Four of these work with a small amount of pregestin, which thickens cervical mucous and prevents sperm from reaching an egg. Known by the brand names Mirena, Kyleena, Liletta, and Skyla, these IUDs can be inserted for a period of three to six years. They can also make your period lighter or disappear altogether. Talk to your doctor about which one might be right for you.

The fifth kind of IUD is made with plastic and a small amount of copper and is called the ParaGard. It prevents sperm from reaching an egg because sperm dislike copper. It does not affect your period and can be worn for up to 12 years.

While many health insurances plans cover IUDs in full, for those women that pay out of pocket, IUDs can cost up to $1,300, though amortized over several years, the cost per week or month of use is low. (7)

How effective is it? All IUDs are 99 percent effective both for perfect and typical use.

Type of Contraception: Barrier Methods

Barrier Method Options: Diaphragm, Sponge, and Cervical Cap

These are older methods of contraception that are still available, but aren’t as effective or as easy to use as other methods. “Sponges or a diaphragm? I don’t want to say they are outdated, but they aren’t talked about as much today by healthcare providers,” says Bond. All three methods need to be inserted into the vagina before having sex, so “they took away from the romance and the whole aspect of engaging in sex,” she says.

Similarly, “a diaphragm doesn’t work that great,” says Greves. “It’s better than nothing, but I don’t remember the last time I recommended it for someone.”

The Quick Diaphragm Details

Diaphragms are a small silicone saucer that fits over the cervix and acts as a barrier for sperm to reach an egg.

Like a diaphragm, the cervical cap is a silicone circle inserted into the vagina up to six hours before intercourse to cover the cervix and prevent sperm from reaching an egg in the uterus. It’s also more effective when used with spermicide.

It can be left in for up to 48 hours.

Effectiveness at preventing pregnancy is between 71 and 86 percent. There are no stats available for perfect use.

It costs between $0 and $200 to be fitted in a healthcare provider’s office, then from $0 to $89 for the cap itself, plus ongoing costs for spermicide. (10)

Barrier Method Contraception Option: Condoms

There are condoms available for men to use as a sheath over the penis as well as for women to use internally in the vagina or anus. Both are used to avoid pregnancy as well as to reduce the transmission of sexually transmitted infections (STIs) from person to person. While male condoms are made from latex, plastic, or lambskin, female condoms are made only from plastic, which helps people with a latex allergy.

Male condoms are available in most drugstores, grocery stores, and health clinics. They can be $0 to $2 apiece and are not typically covered by health insurance.

Female condoms are also found in many drugstores, grocery stores, and health clinics, costing from $0 to $5 apiece. When used with spermicide, they are most effective.

There are several variations of this kind of birth control, also known as the rhythm method or Natural Family Planning. Overall, they work when a woman notices her most fertile days of her menstrual cycle by the kind of cervical secretions in her vagina, as well as measuring basal body temperature (the body’s temperature upon waking) — these are collectively known as symptom-based methods. If a woman is trying to determine fertility based on the length of several menstrual cycles, it is called a calendar-based method. It is used for birth control when a woman actively avoids sex during her most fertile times of her menstrual cycle.

FAM Option: Standard Days Method

This is only effective for women with two or more menstrual cycles that are between 26 and 32 days. (It doesn’t work when cycles are shorter or longer). Generally, the first fertile day is day 8 of a woman’s menstrual cycle, beginning with day 1 when the period first arrives. The last fertile day is day 19. Unprotected sex is avoided starting on day 8 and continuing through the end of day 19.

FAM Option: Two Day Method

This is when a woman checks her cervical secretions twice a day to determine her fertility. If there are no secretions, it is unlikely she is fertile and therefore is less likely to get pregnant, as sperm cannot move toward an egg easily and live up to five days in the vagina without such secretions. If she feels secretions, both on one day and the day after, she is likely in her most fertile period, and therefore more likely to get pregnant.

FAM Option: The Cervical Mucus Method

Cervical mucus has different consistencies throughout the menstrual cycle. Learning the differences can help you understand what's happening in your ovaries and in your cycle. There are several ways to check cervical mucus, and it can be done first thing in the morning. Wipe the vagina before urinating, observe mucus on the underwear upon waking, or reach into the vaginal opening with clean fingers to see and feel the mucus.

Decoding Your Body's Fertility Signals and Patterns

Recording the description of the mucus on a calendar or app will help you see patterns during the menstrual cycle. Menstrual blood may hide cervical mucus, so consider period days fertile ones. Once the period ends, there are typically dry days that may be considered less-fertile days depending on the length of your cycle. As an egg begins to get ready for ovulation, cervical mucus will appear, typically yellow, white, cloudy, and more or less sticky.

Slippery Cervical Mucus Means Fertility

Right before the egg is released (ovulation), mucus gets slippery so it can best help sperm move to meet an egg. This is the most fertile time and when it is best to avoid unprotected vaginal sex. After several days, cervical secretions get more cloudy and sticky, and then disappear. When there are no secretions, this time is considered infertile. This phase continues until the period begins again and the cycle starts over.

FAM Option: Cervical Mucus Plus Basal Body Temperature tracking

Another method often used along with cervical mucus tracking involves taking your temperature upon first waking up in the morning. The body temperature rises slightly when you ovulate, so tracking the rates for at least three months can help predict when you are most fertile (and when to avoid unprotected vaginal sex).

It is recommended to take your temperature at the same time in the morning every day, yet it is important to understand that sickness, stress, fatigue, and other factors can affect the body’s temperature. Consult a healthcare provider or counselor about tracking your observations and how to best interpret your chart for contraception purposes.

FAM Option: Combined or Sympto-Thermal FAM

You can call it the ultimate combo: Using two or three FAM approaches, such as cervical mucus observations, plus a calendar or basal body temperature charting to predict ovulation, the symptom-thermal fertility awareness method increases effectiveness and reduces failure rates compared with the use of one FAM method alone.

This method is when new mothers exclusively breastfeed their new babies for a period of up to about six months. Exclusive breastfeeding means the baby is nursed on demand (during the day and at night), does not use any bottles or pacifiers, is not eating any formula or other foods, and the mother hasn’t had her period return yet, not even spotting, since six weeks after delivery.

LAM efficacy rates are about 98 to 99 percent if the mother follows all the above conditions, but start to decline as soon as an infant eats more than breastmilk, nurses less than on demand, or the mother’s period returns. In these cases, using a second form of contraception, such as a condom, is a good idea to prevent an unplanned pregnancy.

The Bottom Line on Natural Family Planning and Fertility Awareness Methods of Contraception

Fertility awareness methods takes a lot of dedication, both in tracking changes over several months as well as avoiding vaginal sex (or using condoms) when most fertile.

How effective is it? FAM is not the most effective at pregnancy prevention: 76 to 88 percent.

It can cost $20 for supplies (a basal rate thermometer, pen and paper for tracking). (13)

“I don’t think FAM is reliable,” says Bond. “There is pre-ejaculation that can contain sperm that you can become pregnant by. If you are not sure about having some kind of pill, or other hormonal contraception, you should consider using condoms, because they are easy and don’t require that much change in the body.”

Effectiveness of Birth Control: Considering Failure Rates and Other Factors

What makes one method more effective than another? Failure rates are one factor taken into account when public health experts look at reliability and viability. Other important factors include perfect use versus typical use, accessibility, and cost.

Type of Contraception: Pulling Out, or Withdrawal

This is when the man removes his penis from the vagina just before ejaculating. It’s tricky, because pre-ejaculate can form before withdrawal. Avoiding pregnancy means keeping all sperm away from the vagina, and even a small amount of sperm can get into the vagina and lead to pregnancy. This method is best used when combined with condoms.

How effective is it? With perfect use: 96 percent. With typical use, 78 percent. The man needs to withdraw every time during sex.

Type of Contraception: Abstinence and Outercourse

Avoiding any kind of vaginal, anal, or oral sex is called abstinence, and activities such as kissing, dry-humping, masturbating, massage, and talking about fantasies are considered outercourse. The whole idea is to keep sperm away from the vagina to avoid pregnancy.

This method is free, but requires a lot of dedication and willpower. It’s 100 percent effective at pregnancy prevention. (15)

Type of Contraception: Permanent Methods

For women, sterilization or tubal ligation is a way to permanently stop ovulation so you cannot ever get pregnant.

It is 99 percent effective, and requires surgery to seal off the fallopian tubes so that an egg can never reach a sperm and fertilize.

According to Planned Parenthood, it can cost anywhere from $0 to $6,000. (16)

It does not prevent against sexually transmitted infections; condoms would still need to be used to reduce the chances of contracting an STI.

For men, vasectomy is the option for permanent birth control.

It is 99 percent effective, and while vasectomy reversal procedures exist, they are pricey and not guaranteed. Choose vasectomy if you are sure you don’t want to get anyone pregnant.

Want more excitement? Stimulation? Satisfaction? There are several drug-free ways to spice up your sex life.

The Politics of Birth Control

Contraception Access and Affordability

What is an affordable contraceptive option today may not be available tomorrow.Too often, birth control options are determined by health insurance coverage. When the Affordable Care Act was introduced in 2010, it mandated birth control coverage, and helped American women get contraception, such as birth control pills, IUDs, and sterilization, at no cost. Yet with the change in federal government administrations since 2017, laws around birth control may change, too.

Use Resources to Understand All Options: Knowledge Is Power

Knowing what all your birth control options are will help you and your partner chose what works best for you, wherever you are in your life. “I think it’s awesome to be talking about it; a lot of people just don’t know” about birth control, Greves says. “Birth control is always important.”

Healthy Sex and You

Good sexual health is about a whole lot more than avoiding pregnancy or sexually transmitted disease. Sexual health is about how you see yourself as a sexual being, your ability to embrace and enjoy your sexuality, and your sense of truly owning your sexual actions and choices.